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Rickets

Rickets is a disorder caused by a lack of vitamin D, calcium, or phosphate. It

leads to softening and weakening of the bones.

Causes

Vitamin D helps the body control calcium and phosphate levels. If the blood

levels of these minerals become too low, the body may produce hormones

that cause calcium and phosphate to be released from the bones. This

leads to weak and soft bones.

Vitamin D is absorbed from food or produced by the skin when exposed to

sunlight. Lack of vitamin D production by the skin may occur in people who:

y Live in climates with little exposure to

sunlight

y Must stay indoors

y Work indoors during the daylight hours

You may not get enough vitamin D from your diet if

you:

y Are lactose intolerant (have trouble

digesting milk products)

y Do not drink milk products

y Follow a vegetarian diet

Symptoms

y Bone pain or tenderness

o Arms

o Legs

o Pelvis

o Spine

y Dental deformities

o Delayed formation of teeth

o Decreased muscle tone (loss of

muscle strength)

o Defects in the structure of teeth;

holes in the enamel

o Increased cavities in the teeth

(dental caries)

o Progressive weakness

y Impaired growth

y Increased bone fractures

y Muscle cramps

y Short stature (adults less than 5 feet tall)

y Skeletal deformities

o Asymmetrical or odd-shaped skull

o Bowlegs

o Bumps in the ribcage (rachitic

rosary)

o Breastbone pushed forward

(pigeon chest)

o Pelvic deformities

o Spine deformities (spine curves

abnormally,

including scoliosis or kyphosis)

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The goals of treatment are to relieve symptoms and correct the cause of the condition. The cause must be treated

to prevent the disease from returning.

Replacing calcium, phosphorus, or vitamin D that is lacking will eliminate most symptoms of rickets. Dietary

sources of vitamin D include fish, liver, and processed milk. Exposure to moderate amounts of sunlight is

encouraged. If rickets is caused by a metabolic problem, a prescription for vitamin D supplements may be needed.

Positioning or bracing may be used to reduce or prevent deformities. Some skeletal deformities may require

corrective surgery.

Prevention

You can prevent rickets by making sure that your child gets enough calcium, phosphorus, and vitamin D in the diet.

People who have gastrointestinal or other disorders may need to take supplements. Ask your child's health care

provider.

Kidney (renal) causes of poor vitamin D absorption should be treated right away. People who have renal

disorders should have their calcium and phosphorus levels monitored regularly.

Genetic counseling may help people who have a family history of inherited disorders that can cause rickets.

Osteomalacia

Osteomalacia is softening of the bones due to a lack of vitamin D or a

problem with the body's ability to break down and use this vitamin.

Causes

The softer bones seen in persons with osteomalacia have a normal amount

of collagen, which gives the bones its structure, but lack the proper

amount of calcium.

There are numerous causes of osteomalacia. In children, the condition is

called rickets and is usually caused by low levels of vitamin D.

Other conditions that may lead to osteomalacia include:

y Not enough vitamin D in the diet

y Not enough exposure to sunlight, which produces vitamin D in the bodyy Malabsorption of vitamin D by the intestines

Use of very strong sunscreen, limited exposure of the body to sunlight, short days of sunlight, and smog are factors

that reduce formation of vitamin D in the body. The elderly and those who avoid drinking milk are at increased risk

for osteomalacia.

Other conditions that may cause osteomalacia include:

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y Cancer

y Hereditary or acquired disorders of vitamin D metabolism

y Kidney failure and acidosis

y Liver disease

y Phosphate depletion associated with not enough phosphates in the diet

y Side effects of medications used to treat seizures

Symptoms

y Bone fractures that happen with very little

injury

y Muscle weakness

y Widespread bone pain, especially in the

hips

Symptoms may also occur due to low calcium levels.

These include:

y Abnormal heart rhythms

y Numbness around the mouth

y Numbness of arms and legs

y Spasms of hands or feet

Treatment

Treatment may involve vitamin D, calcium, and phosphorus supplements, taken by mouth. Larger doses of vitamin

D and calcium may be needed for people who cannot properly absorb nutrients into the intestines.

Regular blood tests may be needed to monitor blood levels of phosphorus and calcium in persons with certain

underlying conditions.

Prevention

A diet rich in vitamin D and getting plenty of sunlight can help prevent osteomalacia due to a vitamin D deficiency.

Osteoporosis

Osteoporosis is a condition characterized by a decrease in the

density of bone, decreasing its strength and resulting in fragile

bones. Osteoporosis literally leads to abnormally porous bone that

is compressible, like a sponge. This disorder of the skeleton

weakens the bone and results in frequent fractures (breaks) in the

bones. Osteopenia is a condition of bone that is slightly less dense

than normal bone but not to the degree of bone in osteoporosis.

Causes

Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. The body

may fail to form enough new bone, or too much old bone may be reabsorbed, or both. Two essential minerals for

normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce

bones. Calcium is essential for proper functioning of the heart, brain, and other organs. To keep those critical

organs functioning, the body reabsorbs calcium that is stored in the bones to maintain blood calcium levels. If

calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, bone production and

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bone tissue may suffer. Thus, the bones may become weaker, resulting in brittle and fragile bones that can break

easily.

Symptoms

Early in the course of the disease, osteoporosis may cause no symptoms. Later, it may cause dull pain in the bonesor muscles, particularly low back pain or neck pain.

Later in the course of the disease, sharp pains may come on suddenly. The pain may not radiate (spread to other

areas); it may be made worse by activity that puts weight on the area, may be accompanied by tenderness, and

generally begins to subside in one week. Pain may linger more than three months.

People with osteoporosis may not even recall a fall or other trauma that might cause a broken bone, such as in the

spine or foot. Spinal compression fractures may result in loss of height with a stooped posture (called adowager's

hump).

Fractures at other sites, commonly the hip or bones of the wrist, usually result from a fall.

Treatment

Self-Care at Home

If you suspect that you have signs or symptoms of osteoporosis or have risk factors for osteoporosis, see your

doctor for further evaluation and treatment.

Medical Treatment

Treatment for osteoporosis focuses on slowing down or stopping the mineral loss, increasing bone density,

preventing bone fractures, and controlling the pain associated with the disease.

Some 40% of women will experience a broken bone (fracture) due to osteoporosis during their lifetime. In those

who have a vertebral fracture (in their back), one in five will suffer another vertebral fracture within one year. This

condition potentially leads to more fractures. This is called a "fracture cascade." The goal of treatment is to

prevent fractures.

y Diet: Young adults should be encouraged to achieve normal peak bone mass by getting enough calcium

(1,000 mg daily) in their diet (drinking milk or calcium-fortified orange juice and eating foods high in

calcium such as salmon), performing weight-bearing exercise such as walking or aerobics (swimming

is aerobic but not weight-bearing), and maintaining normal body weight.

y Specialists: People who have spinal, hip, or wrist fractures should be referred to a bone specialist (called an

orthopedic surgeon) for further management. In addition to fracture management, these people should

also be referred to a physical and occupational therapist to learn ways to exercise safely. For example,

someone with spinal fractures would avoid touching their toes, doing sit-ups, or l ifting heavy weights.

Many types of doctors treat osteoporosis, including internists, generalists, family physicians,

rheumatologists, endocrinologists, and others.

y Exercise: Lifestyle modification should also be incorporated into your treatment. Regular exercise canreduce the likelihood of bone fractures associated with osteoporosis.

Prevention

Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis

later. The average woman has acquired 98% of her skeletal mass by 30 years of age.

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There are four steps to prevent osteoporosis. No one step alone is enough to prevent osteoporosis.

y Eat a balanced diet rich in calcium and vitamin D.

y Engage in weight-bearing exercise.

y Adopt a healthy lifestyle with no smoking or excessive alcohol intake.

y Take medication to improve bone density when appropriate.

Addison's disease

Addison's disease is a disorder that occurs when the adrenal glands do

not produce enough of their hormones.

Causes

The adrenal glands are small hormone-secreting organs located on top

of each kidney. They consist of the outer portion (called the cortex)

and the inner portion (called the medulla).

The cortex produces three types of hormones:

y The glucocorticoid hormones (such as cortisol) maintain sugar

(glucose) control, decrease (suppress)immune response, and help the body respond to stress.

y The mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance.

y The sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.

Addison's disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its

hormones.

This damage may be caused by the following:

y The immune system mistakenly attacking the gland (autoimmune disease)

y Infections such as tuberculosis, HIV, or fungal infections

y Hemorrhage, blood loss

y Tumors

y Use of blood-thinning drugs (anticoagulants)

Risk factors for the autoimmune type ofAddison's disease include other autoimmune diseases:

y Chronic thyroiditis

y Dermatis herpetiformis

y Graves' disease

y Hypoparathyroidism

y Hypopituitarism

y Myasthenia gravis

y Pernicious anemia

y Testicular dysfunction

y Type I diabetes

y Vitiligo

Certain genetic defects may cause these conditions.

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Symptoms

y Changes in blood

pressure or heart rate

y Chronic diarrhea

y Darkening of the skin -

patchy skin color

y Unnaturally dark color

in some places

y Paleness

y Extreme weakness

y Fatigue

y Loss of appetite

y Mouth lesions on the

inside of a cheek

(buccal mucosa)

y Nausea and vomiting

y Salt craving

y Slow, sluggish

movement

y Unintentional weight

loss

Treatment

Treatment with replacement corticosteroids will control the symptoms of this disease. However, you will usually

need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or

hydrocortisone) and mineralocorticoids (fludrocortisone).

Never skip doses of your medication for this condition, because life-threatening reactions may occur.

The health care provider may increase the medication dose in times of:

y Infection

y Injury

y Stress

During an extreme form of adrenal insufficiency, adrenal crisis, you must inject hydrocortisone immediately.

Supportive treatment for low blood pressure is usually needed as well.

Some people with Addison's disease are taught to give themselves an emergency injection of hydrocortisone

during stressful situations. It is important for you to always carry a medical identification card that states the type

of medication and the proper dose needed in case of an emergency. Additionally, your health care provider may

advise you to always wear a Medic-Alert tag (such as a bracelet)

alerting health care professionals that you have this condition in

case of emergency.

Hemochromatosis

Hemochromatosis is the most common form of iron overload

disease. Primary hemochromatosis, also called hereditaryhemochromatosis, is an inherited disease. Secondary

hemochromatosis is caused by anemia, alcoholism, and other

disorders.

Hemochromatosis causes the body to absorb and store too

much iron. The extra iron builds up in the bodys organs and

damages them. Without treatment, the disease can cause the

liver, heart, and pancreas to fail.

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Causes

Hereditary hemochromatosis is mainly caused by a defect in a gene called HFE, which helps regulate the amount of

iron absorbed from food. The two known mutations ofHFEare C282Yand H63D. C282Y is the most important. In

people who inherit C282Yfrom both parents, the body absorbs too much iron and hemochromatosis can result.

Those who inherit the defective gene from only one parent are carriers for the disease but usually do not develop

it; however, they still may have higher than average iron absorption. Neither juvenile hemochromatosis norneonatal hemochromatosis are caused by an HFEdefect. Juvenile and neonatal hemochromatosis are caused by a

mutation in a gene called hemojuvelin.

symptoms

Joint pain is the most common complaint of people with hemochromatosis. Other common symptoms include

fatigue, lack of energy, abdominal pain, loss of sex drive, and heart problems. However, many people have no

symptoms when they are diagnosed.

If the disease is not detected and treated early, iron may accumulate in body tissues and eventually lead to serious

problems such as

y arthritis

y liver disease, including an enlarged liver,

cirrhosis, cancer, and liver failure

y damage to the pancreas, possibly causing

diabetes

y heart abnormalities, such as irregular heart

rhythms or congestive heart failure

y impotence

y early menopause

y abnormal pigmentation of the skin, making

it look gray or bronze

y thyroid deficiency

y damage to the adrenal glands

Treatment

Treatment is simple, inexpensive, and safe. The first step is to rid the body of excess iron. This process is called

phlebotomy, which means removing blood the same way it is drawn from donors at blood banks. Based on the

severity of the iron overload, a pint of blood will be taken once or twice a week for several months to a year, and

occasionally longer. Blood ferritin levels will be tested periodically to monitor iron levels. The goal is to bring blood

ferritin levels to the low end of normal and keep them there. Depending on the lab, that means 25 to 50

micrograms of ferritin per liter of serum.

y Once iron levels return to normal, maintenance therapy begins, which involves giving a pint of blood

every 2 to 4 months for life. Some people may need phlebotomies more often. An annual blood ferritin

test will help determine how often blood should be removed. Regular follow-up with a specialist is also

necessary.

y If treatment begins before organs are damaged, associated conditionssuch as liver disease, heart

disease, arthritis, and diabetescan be prevented. The outlook for people who already have these

conditions at diagnosis depends on the degree of organ damage. For example, treating hemochromatosis

can stop the progression of liver disease in its early stages, which leads to a normal life expectancy.

However, if cirrhosis, or scarring of the liver, has developed, the persons risk of developing liver cancer

increases, even if iron stores are reduced to normal levels.

y People with complications of hemochromatosis may want to receive treatment from a specialized

hemochromatosis center. These centers are located throughout the country. Information is available from

the organizations listed under ForMore Information.

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y People with hemochromatosis should not take iron or vitamin C supplements. And those who have liver

damage should not consume alcoholic beverages or raw seafood because they may further damage the

liver.

y Treatment cannot cure the conditions associated with established hemochromatosis, but it will help most

of them improve. The main exception is arthritis, which does not improve even after excess iron is

removed.

Myxedema

A condition that can result from a thyroid gland that produces too

little of its hormone. In addition to a decreased metabolic rate,

symptoms may include anemia, slow speech, and enlarged tongue,

puffiness of the face and hands, loss of hair, coarse and thickened

skin, and sensitivity to cold.

causes

Hypothyroidism

Goitre

y Hashimoto's thyroiditis

y Thyroid surgery

y Graves' disease - rarely causes myxedema of knee and shin called pretibial myxedema

Symptoms

The list ofsigns and symptoms mentioned in various sources for Myxedema includes the 24 symptoms listed

below:

y Skin thickening

y Coarse skin

y Change in facial

appearance

y Thickening nose

y Swollen lips

y Puffiness around the eyes

y Jelly-like infiltrations in

subcutaneous tissues

y Slow speech

y Mental dullness

y Lethargy

y Mental problems

y Dry skin

y Yellow skin

y Coarse skin

y Swollen subcutaneous

tissue

y Weight gain

y Constipation

y Thinning hair

y Brittle hair

y Bald patches

y Muscle pains

y Deafness

y Hearing impairment

y Carpal tunnel syndrome

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Treatment

The list of treatments mentioned in various sources for Myxedema includes the following list. Always seek

professional medical advice about any treatment or change in treatment plans.

y Treatment of the underlying cause

y See treatment of hypothyroidism

y Thyroid hormone replacement

y Thyroxine

y Topical corticosteroids

y Compression stockings

Prevention

Myxedema coma can be prevented with early treatment of hypothyroidism, taking thyroid medication regularly,

and recognition of the warning symptoms of myxedema coma.

Cretinism

Cretinism is a condition of severely stunted physical and mental

growth due to untreated congenital deficiency

of thyroid hormones(congenital hypothyroidism) due to

maternal nutritional deficiency of iodine.

Causes

Cretinism can result from a congenital lack of a thyroid gland. This

condition is also known as congenital cretinism. It may also result

from the inability of the thyroid gland to produce sufficient amounts of thyroid hormones that are crucial to the

development of a child due to a genetic defect of the thyroid itself.

The most preventable cause of cretinism is a lack of iodine in the diet. This type of cretinism is called endemic

cretinism. Unlike congenital cretinism, the severity of endemic cretinism varies according to the amount of iodine

in the diet. In some places where the soil is iodine-deficient and sources of iodine are scarce, whole populaces

have been observed to have cretinism tendencies.

Symptoms

Symptoms include execute growth, twined facial

features, increased tongue and mental detainment.

The typical:

y floppy infant

y thick, protruding tongue

y poor feeding

y choking episodes

y constipation

y prolonged jaundice

y short stature

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Frequent Signs and tests:

y sutures - separated widely and a big

posterior fontanelle

y extensive fontanelle and posterior

fontanelle (soft spots)

y dull-appearing facial features

y dry, brittle hair and low hairline

y short, thick neck

y growth failure

y short extremities

y broad hands with short fingers

y myxedema

y hypotonia

y hoarse-sounding cry or voice

Treatment

The list of treatments mentioned in various sources for Cretinism athyreotic includes the following list. Always

seek professional medical advice about any treatment or change in treatment plans.

y Management of congenital hypothyroidism revolves around early diagnosis and treatment, ideally within

the first two weeks of life to prevent neurological damage. Treatments include:

o Screening for hypothyroidism in routine neonatal screening - performed soon after birth in many

countries

o Thyroid hormone replacement therapy - l ifelong

o Monitoring of thyroid function at regular intervals

Goiter

A goiter is an enlargement of the thyroid gland. It is not

cancer.

Causes

There are different kinds of goiters. A simple goiter can

occur for no known reason, or when the thyroid gland is not able to produce enough thyroid hormone to meet the

body's needs. The thyroid gland makes up for this by becoming larger.

There are two types of simple goiter:

y Endemic (colloid) goiter

y Sporadic (nontoxic) goiter

Colloid goiters occur in groups of people who live in areas with iodine-poor soil. These regions are usually away

from the sea coast. People in these communities might not get enough iodine in their diet (iodine is needed to

produce thyroid hormone).

The use of iodized table salt in the United States today prevents iodine deficiency. However, the Great Lakes,

Midwest, and inner mountain areas of the United States were once called the "goiter belt," because a high number

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of goiter cases occurred there. A lack of enough iodine is still common in central Asia, the Andes region ofSouth

America, and central Africa.

In most cases of sporadic goiter the cause is unknown. Occasionally, certain medications such as lithium or

aminoglutethimide can cause a nontoxic goiter.

Inherited factors may cause goiters. Risk factors include:

y Age over 40 years

y Family history of goiter

y Female gender

y Not getting enough iodine in the diet

Symptoms

The main symptom is a swollen thyroid gland. The size may range from a single small nodule to a large neck lump.

The swollen thyroid can put pressure on the windpipe and esophagus, which can lead to:

y Breathing difficulties (may rarely occur with very large goiters)

y Cough

y Hoarseness

y Swallowing difficulties

There may be neck vein swelling and dizziness when the arms are raised above the head.

Treatment

A goiter only needs to be treated if it is causing symptoms.

Treatments for an enlarged thyroid include:

y Radioactive iodine to shrink the gland, particularly if the thyroid is producing too much thyroid hormone

y Surgery (thyroidectomy) to remove all or part of the gland

y Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to iodine deficiency

y Treatment with thyroid hormone supplements if the goiter is due to underactive thyroid

Prevention

The use of iodized table salt prevents endemic colloid goiter.

Graves diseaseGraves disease is an autoimmune disorder that leads to overactivity of the

thyroid gland (hyperthyroidism).

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Causes

The thyroid gland is an important organ of the endocrine system. It is located in the front of the neck just below

the voice box. This gland releases the hormones thyroxine (T4) and triiodothyronine (T3), which control

bodymetabolism. Controlling metabolism is critical for regulating mood, weight, and mental and physical energy

levels.

If the body makes too much thyroid hormone, the condition is called hyperthyroidism. (An underactive thyroid

leads to hypothyroidism.)

Graves disease is the most common cause of hyperthyroidism. It is caused by an abnormal immune system

response that causes the thyroid gland to produce too much thyroid hormones. Graves disease is most common in

women over age 20. However, the disorder may occur at any age and may affect men as well.

Symptoms

y Anxiety

y Breast enlargement in men (possible)

y Difficulty concentrating

y Double vision

y Eyeballs that stick out (exophthalmos)

y Eye irritation and tearing

y Fatigue

y Frequent bowel movements

y Goiter (possible)

y Heat intolerance

y Increased appetite

y Increased sweating

y Insomnia

y Menstrual irregularities in women

y Muscle weakness

y Nervousness

y Rapid or irregular heartbeat (palpitations or

arrhythmia)

y Restlessness and difficulty sleeping

y Shortness of breath with exertion

y Tremor

y Weight loss (rarely, weight gain)

Treatment

The purpose of treatment is to control the overactivity of the thyroid gland. Beta-blockers such as propranolol are

often used to treat symptoms of rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled.

Hyperthyroidism is treated with one or more of the following:

y Antithyroid medications

y Radioactive iodine

y Surgery

If you have radiation and surgery, you will need to take replacement thyroid hormones for the rest of your life,

because these treatments destroy or remove the gland.

Some of the eye problems related to Graves disease usually improve when hyperthyroidism is treated with

medications, radiation, or surgery. Radioactive iodine can sometimes make eye problems worse. Eye problems are

worse in people who smoke, even after the hyperthyroidism is cured.

Sometimes prednisone (a steroid medication that suppresses the immune system) is needed to reduce eye

irritation and swelling.

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You may need to tape your eyes closed at night to prevent drying. Sunglasses and eyedrops may reduce eye

irritation. Rarely, surgery or radiation therapy (different from radioactive iodine) may be needed to return the eyes

to their normal position.

Dental fluorosis

Dental fluorosis is a health condition caused by a child receiving

too much fluoride during tooth development. The critical period of

exposure is between 1 and 4 years old; children over age 8 are not

at risk. In its mild form, which is the most common, fluorosis

appears as tiny white streaks or specks that are often

unnoticeable. In its severest form, which is also called mottling of

dental enamel, it is characterized by black and brown stains, as

well as cracking and pitting of the teeth

Symptoms

Teeth affected by mild fluorosis may show no visible changes or changes visible only to a dental professional.Mild

to moderate fluorosis is characterized by white lines, streaks or spots. In more severe fluorosis, the teeth can

become pitted and have brown, gray or black spots, and the enamel can be misshapen.

The most common symptoms of fluorosis are cosmetic:

Chalky white teeth patches

Yellow stained teeth

Brown stained teeth

Discolored teeth

Soft Spots (or weak teeth)

Treatment

The damage that dental fluorosis causes to the teeth enamel is permanent and not reversible. Dental fluorosis

treatment is targeting in hiding the discoloration of the teeth.

Treatment options depend on the severity of dental fluorosis.

y Tooth whitening - only for mild fluorosis cases. The whitening is achieved by the abrasion of the outer

layer of the enamel in order to remove surface stains.

In cases of severe dental fluorosis the tooth enamel usually becomes porous, and tooth whitening

methods are not recommended as treatment. Dental fluorosis treatment for severe cases of fluorosisrequires covering the affected teeth with restorations, such as :

y Composite bonding. After etching the enamel, a composite resin (with a color matching the other teeth)

is "glued" on to the exterior of the tooth.

y Porcelain veneers. Made out of porcelain, veneers form a ceramic shell over the surface of the tooth,

covering the stains and discoloration caused by the dental fluorosis.

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Tooth bonding and porcelain veneers are relativly expensive dental fluorosis treatments but they can

provide excellent cosmetic results.

Prevention

Parents should take the necessary measures for preventing dental fluorosis on their children teeth :

y Powdered or liquid concentrate infant formula should be mixed with water that is fluoride-free or

contains low levels of fluoride,

y Do not use fluoride toothpaste until the child is two years old unless advised to do so by a dentist,

y For children age two and older, place only a pea-sized amount of fluoride toothpaste on the toothbrush

at each brushing,

y Avoid toothpastes with flavors that may encourage swallowing,

y An adult should supervise the use of fluoride-containing dental products by children younger than six

years old, and check that they do not swallow it.

Skeletal fluorosis

Skeletal fluorosis is a bone disease caused by excessive

consumption of fluoride. In advanced cases, skeletal

fluorosis causes pain and damage to bones and joints.

Causes

Common causes of fluorosis include inhalation of fluoride

dusts/fumes by workers in industry, use of coal as an indoorfuel source (a common practice in China), consumption of

fluoride from drinking water (naturally occurring levels of fluoride in excess of the CDC recommended safe levels),

and consumption of fluoride from the drinking of tea, particularly brick tea.

Symptoms

y In the early clinical stage of skeletal fluorosis, symptoms include pains in the bones and joints; sensations

of burning, pricking, and tingling in the limbs; muscle weakness; chronic fatigue; and gastrointestinal

disorders and reduced appetite. During this phase, changes in the pelvis and spinal column can be

detected on x-rays. The bone has both a more prominent and more blurred structure.

y In the second clinical stage, pains in the bones become constant and some of the ligaments begin to

calcify.Osteoporosis may occur in the long bones, and early symptoms of osteosclerosis (a condition in

which the bones become more dense and have abnormal crystalline structure) are present. Bony spurs

may also appear on the limb bones, especially around the knee, the elbow, and on the surface of tibia and

ulna.

y In advanced skeletal fluorosis, called crippling skeletal fluorosis, the extremities become weak and moving

the joints is difficult. The vertebrae partially fuse together, crippling the patient.

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Treatments

Dental fluorosis is permanent, it cannot be reversed. They are ways however for the dentist to hide the damage.

The treatment will depend on the severity of the damage. When fluorosis is mild, the common approach is to sand

off the layer of the enamel, this process is known as abrasion. In other instances, composite bonding is done to

change the damaged enamel to the color of your teeth. In severe cases, porcelain veneers and used as a shell to

cover the surface of the tooth that has been damaged, this is however an expensive option.

Treatment of skeletal fluorosis involves first remove the source of the problem. If it is the drinking water, then that

needs to be removed and the drinking water de-fluoride. The persons diet may also have to be changed; no other

treatments are really available.

Fluorosis is an irreversible illness that can lead to permanent damage of the teeth and bones. It is important that

your child sees a dentist from early on, this way they can make a early diagnosis of this problem, before it leads to

a more serious situation.

Wilson disease

Wilson disease is a genetic disorder that prevents the body from getting

rid of extra copper. A small amount of copper obtained from food is

needed to stay healthy, but too much copper is poisonous. In Wilson

disease, copper builds up in the liver, brain, eyes, and other organs. Over

time, high copper levels can cause l ife-threatening organ damage.

causes

Wilson disease is caused by a buildup of copper in the body. Normally,

copper from the diet is filtered out by the liver and released into bile,which flows out of the body through the gastrointestinal tract. People

who have Wilson disease cannot release copper from the liver at a

normal rate, due to a mutation of the ATP7B gene.When the copper

storage capacity of the liver is exceeded, copper is released into the bloodstream and travels to other organs

including the brain, kidneys, and eyes.

symptoms

Wilson disease first attacks the liver, the central

nervous system, or both.

A buildup of copper in the liver may cause ongoingliver disease. Rarely, acute liver failure occurs; most

patients develop signs and symptoms that

accompany chronic liver disease, including

y swelling of the liver or spleen

y jaundice, or yellowing of the skin and

whites of the eyes

y fluid buildup in the legs or abdomen

y a tendency to bruise easily

y fatigue

A buildup of copper in the central nervous systemmay result in neurologic symptoms, including

y problems with speech, swallowing, or

physical coordination

y tremors or uncontrolled movements

y muscle stiffness

y behavioral changes

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Other signs and symptoms ofWilson disease include

y anemia

y low platelet or white blood cell count

y slower blood clotting, measured by a blood

test

y high levels of amino acids, protein, uric acid,and carbohydrates in urine

y premature osteoporosis and arthritis

Kayser-Fleischer rings result from a buildup of

copper in the eyes and are the most unique sign of

Wilson disease. They appear in each eye as a rusty-

brown ring around the edge of the iris and in the rim

of the cornea. The iris is the colored part of the eyesurrounding the pupil. The cornea is the transparent

outer membrane that covers the eye.

Treatment

Wilson's disease requires lifelong treatment. If the disorder is detected early and treated correctly, a person with

Wilson's disease can enjoy completely normal health.

Treatment is aimed at removing the copper from organs and tissue and preventing the intestines from absorbing

copper. It is is treated with lifelong use of D-penicillamine or trientine hydrochloride. Patients will also need to take

vitamin B6 and follow a low-copper diet. A low-copper diet includes avoiding mushrooms, nuts, chocolate, dried

fruit, liver, and shellfish.

Prevention

Genetic counseling is recommended for people with a family history of

Wilson's disease.

Marasmus

Marasmus is one component of protein-energy malnutrition (PEM), the

other being kwashiorkor . It is a severe form of malnutrition caused by

inadequate intake of protein and calories , and it usually occurs in the first

year of life, resulting in wasting and growth retardation. Marasmus

accounts for a large burden on global health. The World Health

Organization (WHO) estimates that deaths attributable to marasmus

approach 50 percent of the more than ten million deaths of children under

age five with PEM.

Causes

Marasmus is caused by a severe deficiency of nearly all nutrients, especially protein and calories.Vitamin B5 -

possibly used for treatment of related vitamin B5 deficiency. Both of these deficiencies are exacerbated by

recurrent illnesses that involve diarrhea and vomiting. Although marasmus is concentrated in developingcountries, it also occurs in more prosperous countries.

Symptoms

The list of signs and symptoms mentioned in various sources for Marasmus includes the 7 symptoms listed below:

y Growth retardation y Muscle wasting

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y Impaired immunity

y Lethargy

y Vomiting

y Delayed wound healing

y Loss of fat stores

Treatment

The list of treatments mentioned in various sources for Marasmus includes the following list. Always seek

professional medical advice about any treatment or change in treatment plans.

y Vitamin B5 - possibly used for treatment of related vitamin B5 deficiency

y Marasmus is usually encountered in third world countries and the World Health organisation has outlined

principles of management as follows:

o Prevent and treat

Hypoglycaemia

Hypothermia

Dehydration

Electrolyte imbalance

Infection

Micronutrient deficiencies

o Provide specialised feeds for

Initial stabilisation

Catch-up growth

o Treatment is carried out in a two phase process: initial stabilisation followed by rehabilitation

Prevention

Providing childrens with proper and complete nutritional foods can prevent marasmus and preventing infections

can reduce the risk of marasmus.

Kwashiorkor

Kwashiorkor is a form of malnutrition that occurs when there is not

enough protein in the diet.

Causes

Kwashiorkor is most common in areas where there is:

y Famine

y Limited food supply

y Low levels of education (when people do not understand how

to eat a proper diet)

This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or

during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition.

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Kwashiorkor is very rare in children in the United States. There are only isolated cases. However, one government

estimate suggests that as many as 50% of elderly people in nursing homes in the United States do not get enough

protein in their diet.

When kwashiorkor does occur in the United States, it is usually a sign of child abuse and severe neglect.

Symptoms

y Changes in skin pigment

y Decreased muscle mass

y Diarrhea

y Failure to gain weight and grow

y Fatigue

y Hair changes (change in color or texture)

y Increased and more severe infections due

to damaged immune system

y Irritability

y Large belly that sticks out (protrudes)

y Lethargy or apathy

y Loss of muscle mass

y Rash (dermatitis)

y Shock (late stage)

y Swelling (edema)

Treatment

Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children

who have had this condition will never reach their full potential for height and growth.

Treatment depends on the severity of the condition. People who are in shock need immediate treatment to

restore blood volume and maintain blood pressure.

Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other

sources of calories have already provided energy. Vitamin and mineral supplements are essential.

Since the person will have been without much food for a long period of time, eating can cause problems, especiallyif the calories are too high at first. Food must be reintroduced slowly. Carbohydrates are given first to supply

energy, followed by protein foods.

Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given

supplements with the enzyme lactase so that they can tolerate milk products.

Prevention

To prevent kwashiorkor, make sure the diet has enough carbohydrates, fat (at least 10 percent of total calories),

and protein (12 percent of total calories).

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Submitted by:

Elaine Joy M. Lunasin

BSN2A